PRS AAPS Oral Proofs 2016
Roberto Flores, MD,* Sean Clouston, PhD,† Richard Kirschner, MD,‡ Judah Garfinkle, DDS,§ Barry H. Grayson, DDS,* Court B. Cutting, MD,* Lacey Sischo, PhD,¶ Ceib Phillips, PhD,‖ Hillary Broder, PhD¶
From the *NYU Langone Medical Center, New York, N.Y.; †Stony Brook School of Medicine, Stony Brook, N.Y.; ‡Ohio State University Medical Center, Columbus, Ohio; §Oregon Heath and Science University, Portland, Ore.; ¶NYU School of Dentistry, New York, N.Y.; and ‖Univeristy of North Carolina School of Dentistry, Chapel Hill, N.C.
PURPOSE: We present a prospective, multicenter study comparing outcomes of primary cleft lip and nasal reconstruction with and without nasoalveolar molding (NAM).
METHODS: One hundred ten infants with cleft lip/palate were prospectively studied through 6 high-volume cleft centers. Study participants were nonrandomized to undergo NAM before primary repair (n = 62) or NO-NAM (n = 48). Caregivers rated the severity of their child’s deformity using the Extent of Difference scale preoperatively and at 1 year of age. Standardized photographs of 54 randomly selected study patients were rated by a blinded expert surgeon using the Extent of Difference scale.
RESULTS: Caregivers of NAM patients reported greater improvement in their child’s appearance compared with caregivers of NO-NAM patients (P < 0.05). This improvement was most apparent in the nose: the NO-NAM group showed no significant improvement in the nose over time (B = −0.19, P = 0.299), whereas the NAM group showed a 3-fold greater improvement over time (B = −0.58, P = 0.007). Expert clinician ratings indicated that NAM-treated infants had facial deformities of greater severity at pretreatment (P < 0.05). In addition, there was greater improvement in appearance after surgery in NAM-treated patient. This difference was most evident in the nose (B = −0.52, P = 0.025). There was no statistical difference in postoperative appearance between the NAM and NO-NAM group by clinician rating.
CONCLUSIONS: NAM provides significantly greater improvement in facial appearance after primary cleft lip and nasal repair compared with patients who undergo NO-NAM.